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FOR OH FUSE LL1 2004 STATE OF ILLINOIS DEPARTMENT OF PUBLIC AID FINANCIAL AND STATISTICAL REPORT FOR LONG-TERM CARE FACILITIES (FISCAL YEAR 2004) I. DPH Facility ID Number: Facility Name: 0020842
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How to fill out halsted terrace nursing ctr-2004-0020842:

01
Obtain the form: Start by acquiring the halsted terrace nursing ctr-2004-0020842 form. This can usually be obtained from the nursing center itself or through their website.
02
Read the instructions: Carefully go through the instructions provided with the form. Make sure you understand all the requirements and any specific guidelines mentioned.
03
Personal information: Begin by filling out the personal information section. This typically includes your full name, address, phone number, date of birth, and any other requested details. Ensure that all the information provided is accurate and up-to-date.
04
Health history: Proceed to fill out the health history section. This may require you to provide details about any past surgeries, medical conditions, medications you are currently taking, and allergies, among other relevant health information.
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Contact information: Include the contact information of your primary healthcare provider or physician. This allows the nursing center to coordinate and communicate with your healthcare team effectively.
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Insurance information: Provide details of your insurance coverage. This could include information about your insurance provider, policy number, and any relevant forms or documents required by your insurance company.
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Signature and date: Review the form once completed and ensure all the required fields have been filled out accurately. Sign and date the form as instructed.

Who needs halsted terrace nursing ctr-2004-0020842:

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Individuals seeking admission to Halsted Terrace Nursing Center: The halsted terrace nursing ctr-2004-0020842 form is typically required for individuals who are considering admission to the nursing center. It allows the center to gather pertinent information about the prospective resident's health and other relevant details.
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Caregivers or legal guardians: In some cases, caregivers or legal guardians may need to fill out this form on behalf of the individual seeking admission. This can occur when the person requiring care is unable to complete the form themselves due to physical or cognitive impairments.
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Healthcare professionals: Healthcare professionals involved in the evaluation and admission process may also need access to the halsted terrace nursing ctr-2004-0020842 form. This ensures they have all the necessary information to make informed decisions regarding the individual's care and suitability for admission.
It is important to note that the specific requirements for completing this form may vary depending on the nursing center and individual circumstances. Therefore, it is advisable to carefully follow the instructions provided and seek assistance from the nursing center staff if needed.
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Halsted Terrace Nursing Center (0020842) is a nursing facility located in Illinois.
The administrators or authorized representatives of Halsted Terrace Nursing Center (0020842) are required to file the necessary documentation.
The required information for Halsted Terrace Nursing Center (0020842) can be filled out online or through paper forms provided by the relevant authorities.
The purpose of filing Halsted Terrace Nursing Center (0020842) is to report important data and information regarding the facility's operations and compliance with regulations.
The report for Halsted Terrace Nursing Center (0020842) must include financial data, patient care statistics, staffing information, and other relevant details.
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Relevant keywords

ILLINOIS Halsted 2003 Nsg Ctr 2004 ITEX VII VIII Subunits OHF AVG 12I 12B IDPH 10a SNF LINCOLNWOOD ICF xii reclassification CAREPATH Nonallowable JLR preparer Lavenda 28a rajchenbach SHAYMARK 12A 12H

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